Co-occurring Mental Health and Chronic Health Conditions Among Children
Article Prepared By:  Craig Anne Heflinger, Ph.D. - Principal Investigator
with Andrea Flowers - Data Disseminator

This is a synopsis of a previously published article¹ that emerged from the IMPACT Study². The article compared Medicaid children with and without serious mental health problems and found that chronic health conditions were more commonly found among children with serious mental health problems.

The sample for this study included 965 children between the ages of four and 17 from Mississippi and Tennessee who were Medicaid beneficiaries. The children's parents/caregivers were interviewed, using standardized questionnaires, about their children’s overall physical and psychosocial well-being. The study compared the health status of children with serious emotional disturbance (SED) to those with fewer or no mental health problems. Federal criteria for severe emotional disturbance (SED) were used that require the presence of clinically significant emotional or behavioral problems, as well as severe functional impairment (e.g., not being able to function well at home, in school, with peers, or in the community).

The physical health of the groups of children was compared in several areas including: number of chronic conditions (e.g., asthma, diabetes, allergies), overall health status (i.e., excellent, very good, good, fair, or poor), and physical functioning (i.e., extent to which the child's physical activities such as self-care and movement were limited).

Across the entire sample, 37% of the children had at least one chronic health condition (i.e. asthma or allergies), and half of those had more than one chronic condition. However, that rate was higher for children with SED (43%). The average number of chronic health conditions was also significantly higher among children with SED and children with less severe emotional/behavioral problems compared to children with no mental health problems. The overall health status and physical functioning of the SED group was significantly lower than the other groups. These findings were supported by additional analyses conducted to see what characteristics were associated with poorer health. Again, having SED was found to be significantly related to poorer health status and more limitations in physical functioning. Older children, boys, and African-American children were also found to have poorer health and physical functioning.

Overall, this study found that children with SED tended to have more chronic health conditions and to be in poorer health than other children. These findings suggest a need to screen children with mental health problems for other health problems, and vice versa. For children to receive the best, overall care, every health and behavioral health concern should be identified and addressed through coordination of services. These findings support the need for a comprehensive, integrated system of care for children and their families.

¹ Combs-Orme, T., Heflinger, C.A. & Simpkins, C.G. (2002).  Comorbidity of mental health problems and chronic health conditions in children. Journal of Emotional and Behavioral Disorders, 10, 116-125

² This article is based on one of several reports from the IMPACT Study, conducted by Vanderbilt University's Center for Mental Health Policy in conjunction with Tennessee Voices for Children, the Tennessee Commission on Children and Youth, and Mississippi Families as Allies.  The IMPACT Study focused on mental health and substance abuse issues of school-aged Medicaid children and adolescents in Tennessee and Mississippi, and was funded by the United States Department of Health & Human Services (USDHHS) Substance Abuse and Mental Health Services Administration (SAMHSA) as part of a national study to examine the impact of Medicaid managed care on vulnerable populations.

To download the report this article is based upon, please go to:
www.vanderbilt.edu/VIPPS/CMHP/pdfs/Co-occurring MH.pdf

This report is based on one of a series of reports that are available at:
www.vanderbilt.edu/VIPPS/CMHP/publications.html#Impact

© TVC 2002